AB0337 MENTAL HEALTH AND RHEUMATOID ARTHRITIS
Authors: S. Baliga, R. Samant, C. Balakrishnan
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis(RA) is a chronic systemic inflammatory disorder characterised by symmetrical involvement of small and large joints of the body. It has a prevalence of 0.5 – 1% in the world, affecting more commonly women <sup>[1].</sup>.Due to the inflammatory burden of the disease, RA patients develop articular damage of various joints causing disability, reduced quality of life, and reduced life expectancy<sup>.[2,3].</sup>Patients with long standing or severe disease can also manifest with extraarticular symptoms. These in addition to chronic pain and disability can affect mental status of the patients <sup>[4]</sup>. Poor quality of sleep, anxiety and depression have been thought to contribute to the disease flare.<sup>[5]</sup> DMARDs are the best treatment offered to control disease activity in patients with rheumatoid arthritis.However it is important to emphasize that sleep, depression and stress have also an important role to play in the disease management.Treatment of depression, improvement of sleep quality in addition to DMARDS should always be kept in mind.Through this study we attempt to find there is any correlation of mental health with disease activity in RA. <h3>Objectives</h3> To find the prevalence of depression, anxiety, and disturbed sleep in RA patients. To find the correlation of depression, anxiety and quality of sleep with disease activity in RA. <h3>Methods</h3> A cross sectional study was done on RA patients in a tertiary care centre from western India. A questionnaire-based study was conducted among adult RA patients attending Rheumatology clinic at P D Hinduja Hospital Mumbai between March 2020 to July 2021. Depression was assessed using Becks depression scale, anxiety using Becks anxiety scale and sleep quality using sleep quality scale. <h3>Results</h3> A total of 200 RA patients within 5 years of disease were included in the study. Out of 200 patients, majority (84 %) were females.The prevalence of depression, anxiety and disturbed sleep in our RA population was 23.5%, 27.5% and 44.5 % respectively. Using Spearman correlation, we found a positive correlation of depression(Figure1), anxiety and disturbed sleep with disease activity using DAS 28 score. We also found a positive correlation of number of joints involved with pain (PAS) scores, depression with anxiety, anxiety with both depression and disturbed sleep and poor sleep quality with anxiety. Interpretation: - The p-value of the test is &lt;0.0001.DAS Score and Depression Score are significantly correlated with correlation coefficient 0.29 and P-value &lt;0.0001 <h3>Conclusion</h3> Depression, anxiety, and sleep disturbance is significantly higher in patients with early RA. Rheumatologists in addition to assessing disease activity in RA should also include assessment of the mental health. Early evaluation and intervention might result in better outcomes, reduce disease burden and avoid unnecessary immunosuppressive drug escalation. <h3>References</h3> [1]Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. [2]. Arthritis Rheum. 1998;41(5):778–99. [2]Symmons DP. Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Pract Res Clin Rheumatol. 2002;16(5):707–22. [3]Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev. 2005;4(3):130–31 [4]Cimmino MA, Salvarani C, Macchioni P, Montecucco C, Fossaluzza V, Mascia MT, Punzi L, Davoli C, Filippini D, Numo R. Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis. Rheumatology international. 2000 Sep;19(6):213-7. [5]Yilmaz V, Umay E, Gündoğdu İ, Karaahmet ZÖ, Öztürk AE. Rheumatoid Arthritis: Are psychological factors effective in disease flare? European journal of rheumatology. 2017;4(2):127–32. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.